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成为一名医生需要迷失自我吗zt

(2009-06-25 12:15:13)
标签:

杂谈

分类: 工作思考

附:

Do I have to lose my self in order to become the doctor I want to be?
为了成为一名医生,我们需要迷失自我吗?

(原文网址:http://www.dxy.cn/bbs/post/view?bid=116&id=14916685&sty=1&tpg=1&age=0)

I learned the answer to that question partway through my internship. Not in the hospital but in the checkout line of a local grocery store.
在实习过程中我得到了问题的部分答案。不是在医院而是在当地果蔬杂货铺的结账台边。

The customer in front of me was an older woman — she wore a faux camel-hair coat and had hair dyed a matching color. I remember that she had wanted her groceries bagged in a particular fashion, but the sales clerk, a young woman with impossibly long pink acrylics, was perplexed by the woman’s demands.
我前面结账的顾客是一个老太太——她穿着驼毛大衣染着相同颜色的头发。我还记得她要求她的购物袋有特别的款式,而收银员是一个年轻穿着长袖粉色腈纶的女孩,她对顾客的这个要求不知所措。

I felt as if I had stepped into an avant-garde theatre production. Each time the young woman bagged the groceries, the older woman admonished her and asked her to go through the process yet again. The muscles of my jaw tightened with each round of bagging, and even though I was off for the day, all I could think was: I’ve got sick patients to take care of, I can’t wait for this!
我感觉我好像进入了一个前卫戏剧院。每次女孩打包果蔬杂物,那位老太太都提出她自己的要求并让她重新打包。随着一次次的重复打包,我的喉头一阵阵缩紧,好像时间过了很久似的。当时我的想法就是:我还有生病的患者需要照顾,我不能在耽误时间了。

Unable to bear it any longer, I stepped forward and bagged the woman’s groceries myself, shoving the plastic bags into her arms while resisting the urge to push her on her way. I imagined steam rising from my head as I ranted. But a part of me was as shocked as the people still standing in line. I had never lost my temper in a store, and I had never raised my voice in public. Now, a few months into internship and with a three-minute provocation, I had the capacity to act like a grizzly bear sprung loose from a trap.
不能在等待的我上前替老太太包好她的商品塞进她的怀里,忍住怒气把她送出结账的队伍。我能想象我咆哮时从我头顶升起的怒气,但我惊讶的发现人们仍然整齐的排成一队。在商店中我从未发怒过也从未在公共场所提高嗓门。现在,经历了几个月的实习和3分钟的挑衅后,我就想一只从陷阱中挣脱出来的灰熊一样。

I walked out of the store horrified. That night thinking back on the event, I grew more ashamed of my behavior. But I also realized that it was not the first time I had snapped. Over the previous months, I had thrown myself into my work and shunned everything I once enjoyed and nearly everyone I loved. I believed I needed to do so in order to become a surgeon.
我略带惊恐的离开了商店,整个夜晚对此事的回想都在脑中回荡,我更多的为自己的行为羞愧。但我也意识到这不是我头一次爆发了。在过去的几个月中,我一直全身心在工作中,忽略了几乎所有我所爱的人和自己感兴趣的事。我相信为了成为一个外科医生我必需如此。

But I had lost my self in the process, and the stress made me irritable. I was no longer the nonconfrontational person I once was.
但在这个过程中我迷失了自我,压力是我很急躁。我不再是那个曾经为人随和的我了。

I had, for example, raised my voice a couple of days earlier at a receptionist in the radiology department when she couldn’t schedule my patient for a CT scan. I had scolded a nurse who had had the misfortune of being the fifth person to page me as I scrambled to finish a procedure. And only a week prior, I had squabbled with my family after my mother innocently asked, "Why do you have to work so hard?"
例如,几天前由于不能让自己的病人预约到CT,我对着放射科的登记员大声吼。我对一个在我手忙脚乱的处理完病人时不幸成为第五个传呼我的护士喋喋不休的咒骂。仅仅一周前,当我母亲并无恶意的问我“你为什么如此辛苦的工作?”我还和她拌嘴。

According to a study from the Johns Hopkins University School of Medicine in Baltimore, I am far from the only doctor who has behaved this way. The researchers interviewed residents, or doctors in training, from seven different specialties and found that they set themselves up for burnout by accepting, even embracing, what they believed would be a temporary imbalance between the personal and professional aspects of their lives. While the young doctors interviewed defined well-being as a balance between all those parts, many felt that their medical training was so central to their ultimate sense of fulfillment that they were willing to live with whatever personal sacrifice was required, even if it meant a temporary loss of a sense of self.
根据来自巴尔的摩的约翰霍普金斯大学医学院的研究,我离真正的医生还差得很远。研究者调查了7个不同专业的住院医师或主治,他们发现医生们将自己完全投入到专业训练中,他们认为这是他们生活中个人与专业的暂时不平衡。接受调查的青年医生认为自己各方面都很均衡,许多人觉得他们的医学培训是人生中最重要的所以在个人生活上作出一定的牺牲也是必要的,甚至意味着暂时丢掉自我。

I spoke to the lead author, Dr. Neda Ratanawongsa, who now practices general internal medicine at San Francisco General Hospital and is an assistant professor at the University of California, San Francisco.
我对这个研究的负责人Neda Ratanawongsa博士说,后者目前正在旧金山总医院接受大内科训练并且是加州大学旧金山分校的助理教授,

“It’s partly a coping mechanism,” Dr. Ratanawongsa said. “We tell ourselves that we can do everything but not at the same time, so we are going to put off the thing that defines us as a person — time with children, running a marathon, painting, playing music — in order to get trained because being a doctor is also rewarding.”
“这一部分是无暇应付,” Ratanawongsa博士说。“我们告诉自己我们无所不能但同时又只能做一件事,所以我们放弃了一些作为平常人的事——和孩子相处的时间,慢跑,绘画,玩音乐——就是为了接受训练因为成为医生是如此诱人。”

That delayed gratification works well initially because residents believe it is only temporary. “A lot of what matters to residents at this time is the sense that they are learning to care for patients well and growing as doctors. They feel that what they are doing is going to be worth it.”
一开始让人感到高兴的工作就被不断的推迟但住院医师认为这只是暂时的。“此时对于住院医生们更多的事情是学习如何诊治病人并成为一名医生,他们觉得他们所做的都是值得的。”

But when the imbalance persists for longer than initially expected, professional growth is not enough to sustain most young doctors. “The ones who are happier,” Dr. Ratanawongsa observed, "are the ones who have held on to one or two things and have said, ‘I’m not just another resident. I play the guitar, I run races, or I go home to family.’ They don’t do these things to the same extent as they did before residency, but they do them enough to maintain a sense of self.”
但当这一不平衡超过最初的期望时,专业成长对于大多数年轻医生就不是最充足的理由了。“更快乐的人,” Ratanawongsa博士观察到。“是同时享受几件事的人并且他说,“我不仅是一个住院医师。我还弹吉他,慢跑或常回家和家人在一起”。他们不能像做住院医师前那样享受生活但他们可以保持自我。”

Residents who don’t find this balance are at risk of burnout, clinical depression or, more commonly, subtle forms of stress. “These residents may feel that even if they can give excellent care most of the time, there are times when they snap at a patient or don’t order a test fast enough because they are so burnt out."
那些不会调节生活的住院医师有发生过度工作劳累、临床抑郁或更常见的对压力敏感的风险。“这些住院医可能觉得如果他们能很好的做诊疗,那么如果有几次冲病人高声叫喊或不按预约做检查也是可以理解的因为他们是如此的敬业。”

Although her study focused on doctors in training, Dr. Ratanawongsa sees the same challenges among doctors who have finished and are currently practicing. “There is always this expectation that at some point things will turn around. The interns say, ‘When I finish internship and become a second-year resident, things will get better.’ The residents say, ‘When I finish training, I will finally have balance again.’ And doctors in practice may believe that they will find more balance once they have retired.”
虽然本次研究关注的是在培训的住院医生,但Ratanawongsa博士看到在完成专科培训或正培训住院医生的医生中也存在同样的问题。“我们总是在这个问题上转圈。实习医生说,’当我们完成第一年实习成为两年资住院医师后问题就能化解很多。’住院医师说,‘当我完成专科培训,我终于能过上自己的生活了。’而作指导医生的相信我们在退休后就能过上普通人的生活。”

The danger is that physicians may end up leaving the work force or will become less effective caregivers. Dr. Ratanawongsa suggests that doctors learn how to create a better sense of balance in their lives from the moment they begin training. “We are taught to put our patients before ourselves; it’s in our charter of professionalism. I agree with that, but I also think there has to be some sense that I matter, too, at some point. If something important is going on with our loved ones or with ourselves, we need to be able to advocate for ourselves. And we need time to reflect on who we are and where we are going.”
但问题上内科医生们可能已经不能离开他们的工作或成为力不从心的保姆。Ratanawongsa博士提示说医生们学会从他们开始接受训练的时刻就产生一种使生活平衡的更好感觉。“我们被教育要将病人放在第一位,这是我们的职业操守。我同意上面的说法,但我同时也认为我们自己也同样重要;我们需要呼应一下,还有对于我们自己和我们所爱的人也很重要的事情。我们需要时间反思我们是谁,我们要去哪里。”

In the months after that incident at the grocery store, I continued to devote my life to my training — there was no other way to become the surgeon I wanted to be — but I also learned to find time for myself. Even 18 years later, I can still remember those moments away from work well — late morning breakfasts with the Sunday Times in hand at the greasy diner down the street from the hospital, glorious springtime drives in a friend’s used convertible, afternoons running on a boardwalk and walking along the beach. I lost a few extra hours of sleep each time I did something for myself; but in the end I, and my patients, would gain much more.
在杂货店事件发生后的几个月,我一直全身心投入工作——没有别的方法可以成为我心目中那样的外科医生——同时我也学着给自己留点空间。甚至18年后,我仍清晰的记得工作外的那些时刻——在医院外的路边手拿周日时报吃着油腻的早餐、在春光明媚的日子开着朋友的敞篷车兜风。下午在小路上慢跑在海滩上散步。每天我牺牲一些睡觉时间做上面的事情,结果不仅我自己,我的病人也获益良多。

“My belief,” Dr. Ratanawongsa said, “is that doctors will have a greater capacity to know their patient as a person if they know themselves. That kind of knowledge requires a sense of balance and an understanding of why they chose to become a doctor. It comes down to their capacity to be an empathic, caring and compassionate provider; and it comes not from their medical knowledge but from their soul.”
“我相信,”Ratanawongsa博士说,“如果他们能了解自己那么他们就能有更大的可能去像了解普通人一样了解他们的患者。这样的知识需要一种生活的平衡感及对于自己为何要作一名医生的深刻认识。这会给于他们充满爱心仁慈和真情流露的帮助别人的能力,这种能力不是来自于医学专业知识而是来自他们的心灵。”

“This is something we should never sacrifice, even temporarily.”
“这是我们绝不应该牺牲的,即使是暂时的牺牲。”

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